Meibomian gland dysfunction is an eye condition that is also known as MGD, meibomianitis, meibomitis or lid margin disease. Our meibomian glands are located in our eyelids. These glands are responsible for releasing the lipid or oily layer of our tear film that are crucial in preventing rapid evaporation of our tears.

However, there are instances when the meibomian glands fail to produce or release the oil due to blockage in the glands or thickening of the meibum. This will affect the stability and the quality of the tear film and thereby produce dry eye symptoms even if the test results appear normal.  A recent study by Lemp et al. Cornea 2012, revealed that 86% of their dry eye study cohort had meibomian gland dysfunction.

Diagnosis

Meibomian gland dysfunction is a common eye condition, however, it often goes undetected or undiagnosed. Thus, most of the time, it is left untreated or treated ineffectively that it becomes chronic and severe.

Most of the time, persons suffering from dry eye conditions are treated as if their problem lies in the lack of tear production. They are then prescribed with eye drops that will replace tears in their eyes. On the contrary, however, majority of dry eye patients are suffering from meibomian gland dysfunction and tear replacement will not exactly solve the problem. Hence, proper diagnosis and detection are the keys to treating dry eye condition caused by meibomian gland dysfunction.

Here are some common procedures you may need to undergo to determine if your dry eye condition is brought about by meibomian gland dysfunction:

•    Dry eye questionnaires to assess your eye’s condition.

•    Meibomian Gland Evaluator. This is a hand-held instrument used by your eye doctor to evaluate your meibomian gland secretions during a routine eye examination. If liquid oil is found in the meibomian gland orifice during the assessment with the Meibomian Gland Evaluator, then this is indicative that the meibomian gland is not blocked or obstructed.

•    Measure blink rate, lower tear meniscus height, tear osmolarity, tear break-up time and fluorescein staining techniques.

•    LipiView Interferometer assesses in a quantitative manner the quality of the oil in a patient’s tear film.  This in turn qualifies or disqualifies the patient from a LipiFlow treatment – see below.

•    Schirmer’s and lower tear meniscus height to tell if an aqueous deficiency dry eye disease is present. If the dry eye symptoms and signs are present but the tear volume and the Schirmer’s test are normal, then you have evaporative dry eye disease.

•    Assess the anatomy of the meibomian glands. This now can be done using novel infra red scanning instruments.

Treatment

The treatment for meibomian gland dysfunction would depend on the specific symptoms of the condition. Here are some common treatments:

•    Warm compress to liquefy secretions that have solidified and are blocking the meibomian glands. Warm compress may be applied on the eyelids one to two times a day, lasting for around four minutes each time. This may be followed by an eyelid massage.  It is a particularly cumbersome process, which needs daily treatment ongoing for effective results.

•    Eyelid scrubs.

•    Oral antibiotics or anti-inflammatory drugs like doxycycline and steroid drops for two to four weeks.

•    Omega-3 fatty acid supplements of 1,000mg to 2,000 mg per day. (Usually this equates to 3 – 6 capsules per day). Make sure you take these with food so they are absorbed more efficiently and it does not repeat on you.

•    Topical antibiotic ointments.

•    Proper eyelid hygiene. Makeup and eyeliner are significant contributors.  Eyeliner should be placed on the outside of the eyelash margin not on the inside, where the meibomian glands can be blocked.

•    Topical azithromycin which is anti-inflammatory and anti-microbial and with lipid-modulating properties. In Australia this needs to be compounded by a specialist pharmacist.

•    LipiFlow Thermal Pulsation System. This is a 12-minute treatment that unblocks the meibomian glands by the application of controlled heat to the inner surfaces of lid margins while simultaneously applying pulsating pressure on the outer eyelids.  This is the ultimate MGD and dry eye treatment.  More on this exciting technology in a future post.

As you can see treating meibomian gland dysfunction is complex and needs to be done in a systematic way by an expert in dry eye management.  Enquiries about your dry eyes can be made using the enquiry tab on the right or through the Contact Us tab.

8 Comments

  • by Daniel Parra Posted September 21, 2015 8:59 pm

    Hello, I have been diagnosed with Meibomian glands dysfunction 3 years ago. where this can be treated in Sydney? Thanks.

    • by admin Posted December 31, 2015 12:08 am

      Hi Dani
      The most comprehensive meibomian gland dysfunction clinic in Australia is located in Sydney. More information on dry eyes and meibomian gland dysfunction can be found at The Eye Practice Optometrist Sydney.

  • by Reenie Posted February 28, 2015 6:20 am

    Hi Admin
    I have stopped using warm compresses as they are making my symptoms worse.
    Why would this be happening?
    Reenie

    • by Jim Posted June 21, 2015 6:48 am

      This is because the eyes are often quite inflamed in meibomian gland dysfunction. Heat will inflame the eyes more. You really need to see someone that understands dry eye better. Where do you live?

  • by Jennifer Posted September 12, 2014 8:05 pm

    Hello, I had a brow lift almost 2 months ago and am now suffering from MGD and dry eye. Could this be due to my blinks not being complete or strong enough? Do I need a revision surgery to lower my brow again to make it stronger? I’m doing every treatment possible and am severely suffering.

    • by admin Posted October 2, 2014 6:14 am

      Hi Jennifer
      It is common for us to see patients with significant dry eye after lid surgery.
      Where are you from? Call us in Sydney on (02) 9290 1899 and ask for my personal email address so we can get some more information, before we give you any definite recommendations.
      Regards
      Jim Kokkinakis

  • by Frances Lewis Posted October 25, 2012 6:32 pm

    Dear Doctor i have been diagnosed with meibomian gland blockage. I have been told to use hot compresses on my eyes and use hypromellose as well. Can this been cured and can it go away eventually. I await your reply. Thank you. Frances Lewis

    • by Jim Posted October 26, 2012 8:08 am

      Dear Frances
      meibomian gland dysfunction is a chronic problem and needs management. It is similar to gum disease in that if you tsop brushing your teeth and flossing between your teeth down to your gum line, gum disease comes back and causes more and more damage.

      What you have is a simple maintenance, which might need to get more complicated but run with this and see how you go. Another issue is incomplete blinking. This plays some contribution to meibomian gland dysfunction. Blinking exercises can be considered if you are diagnosed with incomplete blinking. The problem is most practitioners do not look for it because it is not considered an issue… but it is.

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